Provider Demographics
NPI:1417633280
Name:NIGHTINGALE-WARREN, ELANYA D'YNS ENNLI (CRM)
Entity Type:Individual
Prefix:
First Name:ELANYA
Middle Name:D'YNS ENNLI
Last Name:NIGHTINGALE-WARREN
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32483 OAKVILLE RD SW UNIT 76
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-9459
Mailing Address - Country:US
Mailing Address - Phone:541-570-0182
Mailing Address - Fax:
Practice Address - Street 1:877 NW GRANT AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4539
Practice Address - Country:US
Practice Address - Phone:541-752-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-CRM-1970101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)